The brain’s role in pain. The link between mind and body

Pain is an “unpleasant sensory and emotional experience associated with actual or potential tissue damage” (International Association for the Study of Pain). This definition explains pain as a sensory and emotion experience, implying that it is not something physical that you can see or touch. It is something that is processed and controlled by the brain.

This is not to be mistaken with the common misconception that pain can be in “someone’s head” or “imagined”. In fact, all pain is in the brain. For example, if a person were to fall and fracture a bone in their wrist, the nerve receptors in that bone will fire pain signals (electrical impulses) along the nerves in your arm (peripheral nerves) which will transmit the signal into the spinal cord, which will in turn transmit the signal to the thalamus; the relay centre for the brain. The thalamus will relay the signal to the corresponding part of the brain that controls the wrist. Pain is not experienced until the nerve impulses reach the brain and are processed as pain.

We currently know that all physical injuries heal (biologically) as well as possible within 3-6 months. In the example given above, the wrist bone will heal to the best of its ability by 3-6 months and you would expect that the pain signals would cease thereafter, however there are many people in the world that will tell you that they continue to experience pain many years after they have broken a bone. In these cases, the prolonged pain is more likely to be a result of increased sensitivity in the nervous system rather than from the physical injury itself.

Long-term pain is quite complex. Aside from nervous system sensitization, there are a multitude of environmental, biological, social, cultural and psychological factors that can affect the way the brain processes pain. These factors can up-regulate, down-regulate or even distort pain signals making pain disproportionate to the actual injury.

So how can you manage this? Unfortunately there isn’t one simple answer to this problem given the multifactorial complexity of each individual’s pain experience. However there are some lifestyle and behavioural strategies that are the basis of chronic pain management.

This YouTube video from DVCIPM (www.dvcipm.org) is a good resource for explaining pain.

I like to summarise the main principles of chronic pain management with these points:

1. See a doctor or physiotherapist to be screened for any serious conditions that can be masquerading as chronic pain

2. Shift your definition of improvement. Most people focus on reducing pain as the main way of improving. This can be difficult with chronic pain. Try to focus on ways on improving your levels of activity, function and social engagement rather than reducing pain. This can be difficult to accept but it is normally an active approach to pain management that is best.

3. Make lifestyle changes around improving sleeping habits and improving your diet. Sleep and diet are very important to your overall health as well as pain management.

4. Write down a good set of goals. This outlines where you want to be in the long term. Setting some short term and medium term goals are important stepping-stones to achieving your long-term goals.

5. Pace your daily activities to avoid unnecessary flare-ups of pain. This will allow you to have more stability with your daily activities. Increasing you daily activity levels needs to occur slowly and steadily over time.

6. Have a graded exercise program. This should be planned in collaboration with your physiotherapist or other healthcare professional to ensure that you are doing the right exercise program for your condition. Importantly, the exercises should be related to your goals.

7. Speak to your doctor about your medications. Remember, strong pain-killers such as opioids are not the best option for chronic pain as they place you at risk of other health issues and dependence.

These points are simplified for the purpose this article. To get a proper management plan for your chronic pain, see a physiotherapist today. In the mean time, take a moment to watch Dr Jon Ford explain the principles of goal setting, pacing and graded activity in the video section of this website.

Daniel Di Mauro is a McKenzie Credentialed Physiotherapist at Advance Healthcare in St Albans. Daniel has over 8 years of clinical experience, and has a special interest in complex and chronic spinal pain. The clinic in St Albans provides physiotherapy, multidisciplinary pain management, psychology to the area including Keilor, Sunshine and Caroline Springs.